Saddle pulmonary embolism diagnosed by CT angiography

Frequency, clinical features and outcome

Jay H Ryu, Patricia Pellikka, David A. Froehling, Steve G. Peters, Gregory L. Aughenbaugh

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Objective: To assess the frequency, clinical presentation and outcome associated with saddle pulmonary embolism (PE) diagnosed by computed tomographic angiography (CTA). Patients: Retrospective review of 546 consecutive patients diagnosed to have acute PE by CTA from 1 September 2002 to 31 December 2003. Results: Fourteen of 546 patients (2.6%) had saddle PE; 10 were men (71%). None of these patients had pre-existing cardiopulmonary disease. Most common presenting symptoms included dyspnea (72%) and syncope (43%). Hypotension was documented in 2 patients (14%). The most common risk factor for PE was obesity (64%). CTA revealed saddle PE and additional filling defects in the main pulmonary arteries in all patients. Echocardiography was performed within 48 h of the PE diagnosis in 10 patients and revealed right ventricular dysfunction in 8 (80%). All patients were initially managed in the hospital, median length of stay of 4 days (range, 1-45 days). Standard anticoagulant therapy with heparin and warfarin was administered to all patients. Five patients (36%) received additional therapy; thrombolytic therapy was administered to 1 patient (7%) and 4 patients (29%) received an inferior vena cava filter. None of the patients died during their hospitalization. Four patients (29%) died following their hospitalization after intervals of 1, 5, 6, and 12 months, respectively. Causes of death were known in 3 patients, all of whom died from progressive malignancy. Conclusion: Saddle PE in patients without pre-existing cardiopulmonary disease is associated with a relatively low in-hospital mortality rate and may not necessitate aggressive medical management.

Original languageEnglish (US)
Pages (from-to)1537-1542
Number of pages6
JournalRespiratory Medicine
Volume101
Issue number7
DOIs
StatePublished - Jul 2007

Fingerprint

Pulmonary Embolism
Angiography
Preexisting Condition Coverage
Computed Tomography Angiography
Hospitalization
Vena Cava Filters
Right Ventricular Dysfunction
Thrombolytic Therapy
Syncope
Patient Rights
Warfarin
Hospital Mortality
Dyspnea
Hypotension
Anticoagulants
Pulmonary Artery
Echocardiography
Heparin
Cause of Death
Length of Stay

Keywords

  • Computed tomographic angiography
  • Mortality
  • Pulmonary embolism

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Saddle pulmonary embolism diagnosed by CT angiography : Frequency, clinical features and outcome. / Ryu, Jay H; Pellikka, Patricia; Froehling, David A.; Peters, Steve G.; Aughenbaugh, Gregory L.

In: Respiratory Medicine, Vol. 101, No. 7, 07.2007, p. 1537-1542.

Research output: Contribution to journalArticle

Ryu, Jay H ; Pellikka, Patricia ; Froehling, David A. ; Peters, Steve G. ; Aughenbaugh, Gregory L. / Saddle pulmonary embolism diagnosed by CT angiography : Frequency, clinical features and outcome. In: Respiratory Medicine. 2007 ; Vol. 101, No. 7. pp. 1537-1542.
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abstract = "Objective: To assess the frequency, clinical presentation and outcome associated with saddle pulmonary embolism (PE) diagnosed by computed tomographic angiography (CTA). Patients: Retrospective review of 546 consecutive patients diagnosed to have acute PE by CTA from 1 September 2002 to 31 December 2003. Results: Fourteen of 546 patients (2.6{\%}) had saddle PE; 10 were men (71{\%}). None of these patients had pre-existing cardiopulmonary disease. Most common presenting symptoms included dyspnea (72{\%}) and syncope (43{\%}). Hypotension was documented in 2 patients (14{\%}). The most common risk factor for PE was obesity (64{\%}). CTA revealed saddle PE and additional filling defects in the main pulmonary arteries in all patients. Echocardiography was performed within 48 h of the PE diagnosis in 10 patients and revealed right ventricular dysfunction in 8 (80{\%}). All patients were initially managed in the hospital, median length of stay of 4 days (range, 1-45 days). Standard anticoagulant therapy with heparin and warfarin was administered to all patients. Five patients (36{\%}) received additional therapy; thrombolytic therapy was administered to 1 patient (7{\%}) and 4 patients (29{\%}) received an inferior vena cava filter. None of the patients died during their hospitalization. Four patients (29{\%}) died following their hospitalization after intervals of 1, 5, 6, and 12 months, respectively. Causes of death were known in 3 patients, all of whom died from progressive malignancy. Conclusion: Saddle PE in patients without pre-existing cardiopulmonary disease is associated with a relatively low in-hospital mortality rate and may not necessitate aggressive medical management.",
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